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Homecare Medicines
Towards a Vision for the Future – Taking
Forward the Recommendations
Mark Hackett, CEO, University Hospital of North Staffordshire NHS Trust
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Contents
Foreword
1. Approach
2. Governance
3. Patient Engagement
4. Standards and Toolkit
5. Procurement
6. Systems
7. Gain-share
8. Summary of outputs
9. Appendices
Glossary of Terms
Acknowledgment
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Foreword
In the winter of 2011 my first report was
published; ‘Homecare Medicines, Towards a
Vision for the Future’. In that report I spoke of
the importance of homecare medicines and
the support these services provide to over
200,000 people in England who suffer from
both chronic and stable illnesses.
The Chief Pharmaceutical Officer, now of NHS
England, asked me to undertake a review of
the homecare medicines supply and
associated services in England, to establish
what are the current challenges and issues
and what should occur in the future.
My original report addressed a number of
issues summarised in 4 key areas.
Those areas were:
- Patient involvement
- Market Problems
- Governance in NHS trusts and across the
Market
- Collaboration across organisations
In April 2012 a network was established
consisting of colleagues from across patient
groups, NHS, Industry and Department of
Health who were committed to supporting
the implementation of my recommendations.
The recommendations where aligned to 5
themes, with a mix of colleagues from across
all areas leading and contributing to the
delivery.
Those themes were:
Patient Engagement
- With the aim of strengthening patient
engagement, and with the involvement
of their representatives, this task group
was asked to develop a patient charter
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and to advise on a number of documents
for other work streams.
Governance
- This task group was asked to look at the
necessary steps NHS provider
organisations need to take to provide
homecare to the right patients in the
right way – focusing on those
recommendations within the report that
address leadership within trusts, clinical
and financial governance. Barriers that
prevent good practice were explored,
solutions identified and a governance
guide produced.
Standards and Toolkit
- This task group aimed to provide the NHS
with a set of standards in which
Homecare services could be
implemented and maintained, supported
by the governance guidance.
- The group was also tasked with
enhancing the existing toolkit and to
provide tools, which providers would be
able to rebrand and use as their own.
Procurement
- This task group aimed to bring
transparency, better coordination and
sensible commercial arrangements by;
- Making recommendations associated with
improving the procurement models for
use within the NHS
- Identifying opportunities for enhancing
working arrangements between
commissioners , providers and suppliers
involved in the procurement of homecare
medicines services
- Identifying a methodology for quantifying
benefits of procurement to the best
advantage for patients and taxpayers
- Identifying areas where a ‘once only’
approach can maximise benefits within
the system
Systems
- The focus of this task group was to
understand and consider the Hackett
recommendations, define what system
solutions are in place now, what might be
available in the short term and to provide
recommendations for change considering
any wider NHS implications.
- To process map the flows for both the
medicines and the financials and to
consider the requirements for a new
homecare system.
The network was also complimented crucially
by commissioner colleagues developing
guidelines on how commissioners should
share gains with providers, to cover operating
costs and to invest in system development. I
stand firm on the principle of gain share and
see this as a fundamental lever to releasing
the resources in the system to create a much
needed uplift in Homecare services across
England, increasing patient choice.
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1. Approach
The report ‘Homecare Medicines – Towards a
Vision for the Future’ was published in the
winter of 2011. Following ministerial approval
Mark Hackett, as the then CEO for
Southampton NHS Foundation Trust, working
with colleagues in the Department of Health’s
Commercial Medicines Unit (CMU)
established a working group of colleagues
from across provider pharmacy, senior NHS
colleagues and Industry representatives.
This group came together as a steering board
to oversee the implementation of the
recommendations outlined in his report.
Project governance was put in place to
provide the necessary coordination of work
required. The project became known as;
‘Homecare Medicines, Towards a Vision for
the Future – Taking Forward the
Recommendations’.
The recommendations were aligned to the
following themes and task groups initiated to
develop the outputs required to embed the
change across the NHS and Industry:
- Homecare medicine governance strategic
and operational
- Patient engagement
- Homecare medicine standards and toolkit
for both implementing and maintaining
homecare services
- Procurement and transparency
- Systems and technology required
- Gain-share of savings
Leadership of the task groups was managed
through a dual partnership of both an NHS
lead and deputy Industry Lead. Task groups
were then resourced with interested and
willing delegates from across the field.
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2. Governance There are two main types of homecare
medicines arrangements: those where the
hospital contracts directly with a homecare
provider and those where the hospital
purchases medicines that include the
provision of homecare services, which are
contracted by the manufacturer of the
medicines.
In either case it is vital for patient safety, for
outcomes and for patient experience, as well
as for good use of resources that appropriate
governance arrangements are in place.
The recommendations made in the original
report in summary were:
- Adverse incidents reported by
homecare providers are addressed in
NHS organisations.
- The Trust Chief Pharmacist is
accountable officer
- A strategy for homecare medicines is
set in each trust
- Plans are made to identify patients
who may benefit from homecare
- A shared governance framework is in
place
- Medicines are ordered via pharmacy
- An annual programme for homecare
is established
- An appropriate group oversees the
homecare arrangements in each trust
The task group and its members led by Martin
Stephens, then of University Hospital
Southampton NHS FT, and Steve Cook,
National Clinical Homecare Association
(NCHA), set out to deliver a document which
provided guidance on what governance
should be put in place and how it should be
implemented.
A governance guide has been produced (see
Appendix A) and provides any NHS
organisation aspiring to implement or
improve the governance of existing
arrangements with some key principles to
adopt. The principles range from specific
arrangements that should be in place, the
Chief Pharmacist’s Role, procurement and
management of Homecare Services.
The governance guide can be found via a link
within the Homecare Medicine Handbook and
is to be used with consideration of the
following recommendations:
- The chief pharmacist leading the
homecare programme.
- Medical and nursing directors, along
with the chief pharmacist, ensuring
that issues arising in homecare
provision have the same scrutiny as
those for inpatients.
- Homecare arrangements fully
compliant with business and financial
requirements.
- All homecare procurement being
processed through the pharmacy
system
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3. Patient Engagement
The capability to be able to deliver and or
administer patient medicine away from the
hospital plays a vital role in improving and
increasing patient choice over the ways in
which the NHS serves them. Whilst benefits
for the NHS may also occur, improving patient
choice must be the sole driver for providing
homecare medicine services. Therefore, it is
obvious that with the patient at the heart of
these services, we should seek to increase the
involvement and influence they have over the
services provided.
The report is clear in its recommendations
to:
- Develop a homecare medicines
patients charter
- Support greater choice
- Engage patients in decisions
- Encouraging feedback from patients
- Choice of delivery times
The patient engagement task group, led by
Martin Stephens, then of University Hospital
Southampton NHS FT, and Richard Huckle
(NCHA), engaged with a number of bodies
whose members represent various patient
groups, ranging from physical health to
mental health fields.
The NHS Homecare patient charter has been
delivered, and is recommended for approval
by NHS England. This product was developed
by the task group and can be found within the
Homecare Medicine Handbook. (See
Appendix B)
It should also be noted that whilst the charter
sets out the rights and responsibilities of the
patient, it is for NHS organisations to ensure
that these are committed to in contractual
arrangements, and that the standards set out
by the ‘Homecare Medicine, Towards a Vision
for the Future – Taking Forward the
Recommendations’ project board are adopted
and adhered to.
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4. Standards and Toolkit
‘Homecare Medicines: Towards a Vision for
the Future’ report identified areas of
weakness in the current arrangements for
managing homecare services. One of the key
recommendations of the report was that
Homecare providers and the NHS should have
a clear set of industry delivered standards.
The Standards and implementation handbook
task group, led by Ray Fitzpatrick of Royal
Hospital Wolverhampton, and Carol McCall of
National Clinical Homecare Association
(NCHA), was asked by the Homecare
Medicines Strategy Board to develop and
publish such standards and a supporting
handbook to help organisations comply with
these standards.
The chairs of the task group recognised that
they needed to work with a partner
organisation for the following reasons:
The outputs needed to be on a web
based easily accessible platform, so
that standards and the handbook
could be updated periodically.
There was minimal resource available
to the strategy board to support
delivery.
There was an urgency to have both
the standards and handbook
published to a wide audience via an
authoritative route.
The original report recommends the Chief
Pharmacist is designated as the responsible
person for homecare within NHS
organisations. The task group therefore
agreed that the most appropriate body to
engage with was the Royal Pharmaceutical
Society (RPS)
The Homecare Standards, it was agreed after
consultation with the RPS, would focus on 3
key areas:
- The Patient Experience
- Implementation and Delivery of Safe
and Effective Homecare Services
- Governance of Homecare Services
A total of 10 standards have been developed
that complement the existing ‘RPS Hospital
Pharmacy standards’.
The standards delivered by the task group
were reviewed, and received input from;
National Homecare Medicines Committee,
National Clinical Homecare Association,
Pharmaceutical Market Support Group
(PMSG), National Pharmaceutical Supply
Group (NPSG), National Pharmaceutical Q.A.
Committee, Association of the British
Pharmaceutical Industry (ABPI) Homecare
group, British Generic Manufacturers
Association (BGMA), Chairs of Chief
Pharmacists networks.
The draft standards were then sent out for
formal consultation to wider stakeholder
groups, including the various professional
regulatory bodies and the Medicines and
Healthcare Regulatory Agency (MHRA).
The final draft received both project board
approval and internal RPS approval.
The standards were published on the RPS
website www.rpharms.com during September
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2013 and officially launched at the British
Pharmaceutical Conference on 9th September
2013 (see Appendix C).
The existing NHS Toolkit for Homecare
Services has been in circulation for a number
of years now. Recommendations had been
made to bring this up to date and with the
introduction of the standards the two should
be aligned to provide a comprehensive
handbook for NHS organisations.
The purpose of the handbook is to provide
guidance and supporting documentation to
organisations, particularly but not exclusively
to NHS hospitals, to help in the delivery of
homecare services in line with the RPS
Professional Standards for Homecare Services.
The handbook has therefore been organised
around the same domains as the standards,
and support documents have been cross
referenced to specific standards ensuring
sections covered all key elements of the
homecare process. (See Appendix D)
Each section contains information and
guidance and identifies key documents that
will help homecare teams manage homecare
services within a governance framework, as
set out in the RPS standards. Each document
has been given a status:-
*** Documents approved for national
use by multidisciplinary bodies after
wide consultation
** Examples from existing homecare
services which are consistent with the
best practices described in the RPS
Professional Standard for Homecare
and the Handbook.
* Example documents developed and
used locally by Homecare teams.
Considered to be useful, but need to
be reviewed carefully and adapted
before use. They are likely to have
been prepared prior to the
publication of the RPS Professional
Standard.
The handbook is due for publication via the
RPS website in May 2014. www.rpharms.com
Future stewardship arrangements for
Standards and Handbook; an expert
Homecare Reference Group has been
established by the RPS to develop the content
and format of the publications. This
Homecare Reference Group comprises
individuals from the various sectors involved
in the management and delivery of homecare
including NHS, homecare providers,
pharmaceutical industry and RPS professional
development team and will draw on the
expertise of existing NHS and industry groups
such as the National Homecare Medicines
Committee, the National Clinical Homecare
Association.
The RPS Homecare Reference Group will
direct the future updating and development
of the standards and implementation
Handbook and is committed to full
engagement with the future Homecare
DH/NHS England and NHS oversight body(s).
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5. Procurement
The original report highlighted the size and
scope for growth of homecare medicine
service across England. With this, the focus on
getting the best value contracts on both price
and quality is a critical success factor for
ensuring patients are receiving the best
service possible, and that the NHS is able to
avoid costs at what is a significant financially
challenging time for our Health system.
The recommendations in the report can be
summarised as the following:
- To make recommendations
associated with improving the
procurement models for use within
the NHS
- To identify opportunities for
enhancing working arrangements
between commissioners , providers
and suppliers involved in the
procurement of homecare medicines
services
- To identify methodology for
quantifying benefits of procurement
to best advantage for patients and
taxpayers
- To identify areas where ‘once only’
approach can maximise benefits
within the system
- To ensure opportunities for crossover
with other work streams are
maximised
Essence of recommendations, related
objectives and their current status
Stability for providers based on
identifiable and stable profitability
levels, cash flows and realistic cost
bases and willingness to take risks
Unbundling of homecare medicines
dispensing, delivery and associated
service costs – delivered
recommendation for all national
frameworks facilitated by CMU.
Activity within the NHS it is
recommended that in order to set
clear transparent arrangements this
approach is taken by the NHS.
The Homecare schemes which are facilitated
and managed by the manufacturer and the
homecare provider transparency of the
service in terms of dispensing, delivery and
associated costs is still to be delivered.
Focus on transparency of the non
commercial content of
manufacturers’ SLAs with homecare
providers and publish details of
specifications on NHS facing IT
system. This will provide NHS with a
transparency that is currently
unavailable and will allow comparison
and evaluation of the services offered
between manufacturers, providers
and therapies involved. CMU
commissioned system development.
Delivered system specification, launch
date of CMU system to be confirmed
Develop and engage with industry to
establish clear and transparent cash
flow mechanisms to limit barriers to
entry – recommendation; new models
established, worked and discussed
with industry, establishing contract
pricing from the start of the
framework/contract which has been
delivered for one of CMU’s national
frameworks this enabled providers to
manage cash flows more effectively
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and are not awaiting reimbursement
at a contracted price. Review the
possibility of consignment stock, work
closely with industry to look at a new
structure within the market to
mitigate risk due to pressures of the
current cash flow system within
homecare Deliver by December 2014
recommend establishing an
industry/NHS group and a sub group
from PMSG to develop model.
Baseline report of service providers –
completed and available on the CMU
website.
contract duration to deliver greater
stability for suppliers –
recommendation to be delivered by
December 2014 in conjunction with
sub group of PMSG
stimulation of innovation -
recommend debated in conjunction
with the industry/NHS group –
currently linked with systems task
group
Provider service provision with capacity to
meet the needs and choices of growing
number of homecare patients and with
the ability to absorb shocks in the event
of company failure or withdrawal, for
example
organisation of future service
provision to minimise risks to patient
care as the result of supplier or
provider failure or withdrawal from
the market – to be delivered as a
supplement to the report by
December 2014 in conjunction with
PMSG and NHSE lead for all services
appointment of appropriate external
organisation commissioned to asses
market conditions and supplier
resilience – recommended
collate evidence of robust
arrangements to monitor existing
suppliers via manufacturer managed
arrangements – recommended in
conjunction with CMU NHSE Lead for
all services
commission detailed financial analysis
of homecare medicines providers at
national level – recommended in
conjunction with CMU and NHSE lead
for all services
CMU established monitoring system
for financial assessment of suppliers
on current national agreements –
delivered proposed methodology
Collate evidence of adherence to
procurement to establish real and
actual delivered volumes – CMU
delivered in conjunction with industry
MI data templates for all national
frameworks – recommend this is
available for the NHS.
Audit programme – recommend
establishing a programme of clinical,
financial, nursing logistics and
commercial audits of all current
homecare providers recommend NHS
and NHSE have access to this
information. To be facilitated with
NHSE lead for all services
collaborative purchasing within the
NHS organised at appropriate level –
national or regional – based on
therapy, patient numbers, reduction
of duplication, market characteristics,
delivering optimal service for patients
and value for money for tax payers.
Recommendation; to be delivered as
a supplement to the report by
December 2014 in conjunction with
PMSG.
develop national standards –
Standards task group delivered,
launched on the RPS website
www.rparms.com
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terms and conditions for homecare
services – commenced and ongoing
through DH policy programme
Provide standard national template
documents – delivered currently
within the toolkit and available on the
RPS website.
Specification design – delivered via
the CMU Homecare team in
conjunction with the NHMC final
launch May 2014.
full review of all documentation –
delivered and ongoing by inclusion in
toolkit
formal high profile launch of finalised
documentation – recommended
Suitable national and regional
contract documents for homecare –
delivered and available on CMU
website, due to be re-launched May
2014.
commissioner relationships – current
Strategy Board chaired by Mark
Hackett replaced by equivalent group
reporting to NHS England with NHMC
reporting to this group in order to
provide strategic advice to support
the commissioning of homecare –
recommended
NHS England replacement board to
monitor application of recommended
levels of purchasing with NHS England
giving its authority to ensure
recommended levels of contract
involvement (national or regional) are
adhered to – recommended
CMU frameworks for Enzyme
Replacement Therapy, Home
Parenteral Nutrition , Pulmonary
Hypertension and Blood clotting
Factors delivered in line with Report
Recommendations and NHS England
authority with ongoing review to
inform future design considerations
(benefits, patient numbers, number
of specialist centres)
Trust operational costs and
investment – delivered NHS Gain
share Policy
initial levels of contracting by therapy
– paper developed by PMSG this will
provide NHS England with the basis of
strategic advice in commissioning of
any homecare related prescribing –
recommend sub group of PMSG to
publish findings
measure performance using
nationally agreed KPIs – delivered via
CMU subgroup of NHMC and
submitted into the toolkit
operational testing of these KPIs –
commenced with all CMU frameworks
National roll out of these KPIs –
recommended following operational
testing, nationally collected across all
therapy areas – support from NHSE
national lead.
adoption of KPIs and standard
specification by manufacturers for
their homecare schemes –
recommended
collate evidence of adherence to
procurement to establish real and
actual levels delivered business
volumes – recommended
NHS process steps to establish
homecare service – delivered via
toolkit
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6. Systems The focus of this task group was to
understand and consider the Hackett
recommendations, define what information
management and data transfer systems are in
place now as these deliver operational
efficiencies, what might be available in the
short term and to provide recommendations
for change considering any wider NHS
implications.
To process map the flows for both the
medicine and the payment and to consider
the requirements for a new homecare system
i.e. what the system solutions would/might
be.
- To confirm the current position and
consider what is feasible in the short
term to support all relevant parties.
- To develop an Output Based
Specification (OBS) for a medicines
homecare system / module.
- To develop a technical specification
with exemplar case studies to
demonstrate that wholesale system
change is not require – existing
systems are being used to deliver
significant efficiencies.
- To consider the strategic fit of any
system development that supports
medicines optimisation including
Quality, Innovation, Productivity and
Prevention (QIPP).
- To engage with a wide stakeholder
representative group to ensure
engagement in this workstream.
In summary a number of recommendations
outlined in the report have some dependency
around capability of the technology
infrastructure that supports the delivery of
homecare services; from prescribing to
enabling patients to be able to provide
feedback online.
The task group, led by Andrew Alldred,
Harrogate and District NHS FT, and Graeme
Duncan, NCHA, took a two staged approach;
providing short term recommendations to
NHS organisations on how to improve the use
of the current systems within the
infrastructure in particular JAC and Ascribe,
and providing an Output based specification
(OBS) and Technical specification for
consideration of the future wider NHS
technology infrastructure.
An initial stakeholder event took place in
September 2012 where around 70 delegates
from across the field, and including leading IT
suppliers, came together to develop a
comprehensive list of requirements. A
number of recommendations were then
agreed and compiled feeding into the
development of the OBS and the Technical
specification.
Since that day the work stream members
have worked to deliver 3 key products for the
ongoing discussion surrounding technology;
- Pharmacy Systems Homecare
recommendations (Appendix E)
- Output based specification (Appendix
F)
- Technical specification (Appendix G)
The workstream leaders are continuing a
dialogue with NHS England colleagues
regarding the relationship between homecare
provision and e prescribing systems, and with
HSCIC colleagues on the future potential of
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accessing EPS functionality to support
electronic transfer of homecare prescriptions,
to reflect and build on the standards,
principles and practices already established in
primary care.
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7. Gain-share Achieving Savings from High Cost Drugs
November 2012, Clare Howard, now Deputy
Chief Pharmaceutical Officer NHS England, in
her report stipulated how commissioners
and providers of NHS services can work
together to achieve significant savings in the
use of high cost drugs which are excluded
from the Payment by Results (PbR) tariff.
The majority of medicines supplied via
Home Care are excluded from the PbR
Tariff. Therefore, this framework is
pertinent to ensuring maximum efficiencies
are realised from the Home Care medicines
bill, which is now over £1 billion per year.
The scope for savings was outlined as
follows:
Currently, it is estimated that approximately
60% of the cost of medicines used by
providers of secondary and tertiary care
may be accounted for by medicines which
fall outside the scope of the PbR tariff. In
England, the spend on medicines in
hospitals in 2011 was around £4.3 billion.
Therefore, we can reasonably assume that
the cost of PbR excluded drugs in England
could be up to £2.6 billion per year. Some
Trusts, especially tertiary care centres,
report that their PbR excluded drugs
account for significantly more than 60% of
their total drug spend.
As recently as March 2012 a poll of the then
ten Strategic Health Authority (SHA) Lead
Pharmacists ‘ demonstrated that only two
reported having a region wide template or
framework that was ratified to encourage all
Trust and Primary Care Trusts (PCTs) to have
some levels of gain sharing in place. The other
regions expressed that either they were
exploring a region wide approach, or that they
were aware that some Trust and PCTs had
such an arrangement in place.
NHS England published its ‘Principles for
sharing the benefits associated with more
efficient use of medicines not reimbursed
through national prices” in January 2014. (See
Appendix H)
This work builds on the Gain share principles
originally produced via the DH QIPP Medicines
use and Procurement work group. The NHS
England Specialised Commissioning Medicines
Optimisation Clinical Reference group is
currently working to share worked examples
of good “gainshare arrangements” as we
move, over the next 2 years to more
consistent arrangements across the country.
(For details of the work of the MO CRG see
Appendix J )
Mark Hackett also raised this subject in his
presentation to the Procurement Distribution
Interest Group (PDIG) chaired by Allan Karr,
National Homecare Medicines Committee
(NHMC) in November 2013.
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8. Summary of Outputs Work stream Key Outputs Appendix
Ref
Governance Governance guidance document A
Patient Engagement Patient Charter incorporated into the Homecare Services Handbook Recommendations
B
Standards & Handbook RPS Professional Standards for Homecare Services Handbook
C D
Procurement Online tool for publishing Service Level Agreements
Systems Pharmacy Systems Homecare recommendations Output based specification Technical specification
E F G
Gain-share Gain share framework and guidance Medicines Optimisation Clinical Reference Group
H J
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9. Appendices
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Appendix A
A guide to governance arrangements for homecare medicines for
NHS providers
1.0 Introduction
Homecare medicines services provide an effective means for delivering care in the patient’s
home – reducing the need to travel to secondary or tertiary care providers. Homecare medicine
services are defined as arrangements for delivering medicine supplies, and, where necessary,
associated care, initiated by the hospital prescriber, direct to the patient’s home with their
consent. There are two main types of homecare medicines arrangements: those where the
hospital contracts directly with a homecare provider and those where the hospital purchases
medicines that include the provision of homecare services which are contracted by the
manufacturer of the medicines. In either case it is vital for patient safety, for outcomes and for
patient experience, as well as for good use of resources that appropriate governance
arrangements are in place. This document sets out the key issues that organisations must
address.
2.0 Background
The Department of Health commissioned a review of homecare medicine services and published
a report in late 2011: ‘Homecare Medicines – Towards a vision for the future’
http://cmu.dh.gov.uk/files/2011/12/111201-Homecare-Medicines-Towards-a-Vision-for-the-
Future2.pdf
Following the report a national project board was established to oversee implementation of the
recommendations. This governance guide is one output from that group. The guide refers to
more detailed working papers which can be found on the Commercial Medicines Unit homecare
pages in the homecare medicines handbook.
3.0 Commissioning context
Provider organisations are responsible for the safe and effective provision of medicines for their
patients but this is done in the context of meeting the requirements set by commissioners.
There is an expectation that dialogue with commissioners will shape the way homecare
provision is available for patients.
4.0 Overarching arrangements
Chief Executives should ensure the following arrangements are in place:
4.1 Patient needs are placed at the centre of arrangements for homecare medicines and they
are involved in decisions to use homecare arrangements.
4.2 Provision of homecare medicines is included in assurance arrangements for trust boards.
4.3 The Medical and Nursing Directors ensure that clinical governance arrangements cover the
use of homecare medicines. This must include: incidents relating to homecare medicines
receiving the same scrutiny as similar incidents that occur in the inpatient setting; risks relating
to homecare medicines being included, where necessary, within the trust’s risk register. Where
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there are complex arrangements involving more than one NHS organisation, clarity of
responsibility and accountability must be agreed and understood by all parties.
4.4 The Director of Finance ensures that procurement arrangements for homecare medicines
meet the standards for business conduct and standing financial instructions.
4.5 The Chief Pharmacist is identified as the accountable officer for ensuring the safe and
effective provision of homecare medicine services.
4.6 The officer responsible for business conduct arrangements must ensure declarations of
interest relating to homecare medicines and companies providing these services are dealt with
as for all other matters.
4.7 The Caldicott Guardian must ensure appropriate information governance arrangements are
in place for homecare medicines.
4.8 The Medical Director, Director of Nursing and Chief Pharmacist must ensure that
professionals involved in the provision or use of homecare medicines have the appropriate
knowledge and skills to do so effectively and that relevant professional standards are met.
5.0 The Chief Pharmacist’s Role
As Accountable Officer the Chief pharmacist should ensure that the following are in place:
5.1 At an appropriate level, which may be trust-wide or led by clinical directors at sub-
organisational level, there is a strategy for the use of homecare medicines that meets
organisational and patients’ needs. This should normally include a three year plan and must be
developed with appropriate commissioner support and subject to annual updates as
appropriate.
5.2 A homecare medicines policy setting out the local approach to procurement, supply,
monitoring and use of homecare medicines. An example is available in the Handbook on
Homecare Medicines.
5.3 Arrangements to oversee and monitor homecare medicines use, for example the Trust’s
Drug and Therapeutic Committee or equivalent may be best placed to do this. These
arrangements should include an annual report which reviews performance and sets out plans for
the coming year; an example is available in the Handbook on Homecare Medicines.
Text Box 1 Example of good practice
Whilst a number of organisations across the UK have tackled the issues around
homecare well, The Leeds Teaching Hospitals NHS Trust provides an example of good
practice. Their purchasing arrangements, reporting and governance systems for
homecare. Phil Deady leads the pharmacy procurement team. Details of
arrangements can be found at http://www.ghp.org.uk/groups/UAS@GK/JTHYST/IDNRAR
or
http://medicinesprocurement.co.uk/ebooks/A18m2s/bjmpvol1iss1/resources/29.htm
Contact for Leeds: [email protected]
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6.0 Procurement
The Director of Finance must ensure that the following principles are applied to procurement of
homecare medicines:
6.1 All homecare medicines must be purchased through pharmacy to ensure data are captured
via pharmacy purchasing systems [this ensures information can be collated nationally via the
Commercial Medicines Unit system Pharmex to inform pricing discussions].
6.2 A collaborative approach is encouraged but whether national, regional or local there must be
compliance with procurement legislation for contract awards. The Handbook on Homecare
Medicines provides advice on these issues .
6.3 For all homecare medicine procurement there must be segregation of duties in respect of
the 'purchase to pay' process. That is:
-ensuring that the goods ordered matches the prescription
-ensuring that the goods received matches the order
-ensuring that the invoice matches the goods received and has the correct price (known by
auditors as the '3 way check')
6.4 In addition to national information feedback (5.1) there must be the ability to report
routinely on how much is being spent on Homecare Medicine services.
6.5 There must also be the ability either to charge commissioners for each individual patient's
Homecare Medicines or being able to provide individual patient level analysis to support any
aggregate billing.
7.0 Managing homecare services
When setting up new services and in the ongoing management of services the following must be
addressed.
For the overall service:
7.1 There should be an agreed documentation which sets out key performance indicators and a
means of monitoring those indicators. There are nationally agreed KPI which will populate these.
Where homecare arrangements are set up by manufacturers, NHS organisations can expect to
have access to the details on performance so that these may be monitored. An example
document is available in the Handbook on Homecare Medicines
7.2 Arrangements should include the reporting of all incidents (whether complaints, errors or
other issues) to the trust so that these can be considered within normal governance systems. An
example is available in the Handbook on Homecare Medicines.
7.3 Arrangements should be in place to receive feedback from patients on their experience of
homecare medicines services being used by the trust. Views of users should also be taken into
account when developing new homecare medicines services.
Text Box 2 Example of service seeking to improve
As for a number of hospitals, Sheffield Teaching Hospital NHS FT identified areas for
improvement in the way they handle homecare medicines. A key step was to survey
clinical areas to capture data on homecare purchasing that had not survey to capture
details of homecare currently not purchased through pharmacy.
Contact for Sheffield, Chief Pharmacist: [email protected]
20
For individual patients:
7.4 A clear agreement on the responsibilities of the hospital, the homecare company, the patient
and the general practitioner with respect to the medicines included in the homecare service
should be set out.
7.5 There must be timely, accurate and full communications with the patient’s general
practitioner regarding medicines being provided via homecare services. This will need to include
information at discharge following any admission.
7.6 There must be clear arrangements, explained to the patient and supported with written
information, what they should do in case of non-delivery or incorrect delivery of their medicines.
7.7 There must be clear arrangements, explained to the patient and supported with written
information, what they should do if clinical problems arise or if they are not able to adhere to
the agreed regimen.
8.0 Additional documents
Also available in the Handbook on Homecare Medicines are:
8.1 Implementing a new homecare medicine service
8.2 A patient charter for homecare medicines
8.3 Policy and Strategy model for homecare medicines services
8.4 Suitability and needs assessment tool re patient’s home for assessing appropriateness of
initiating a patient on homecare.
Text Box 3 Example of service seeking to improve
University Hospital Southampton required improvement in homecare medicines as not all
items were purchased via the pharmacy system, they also needed to repatriate invoices that
had been paid by PCTs. Pharmacy with finance built a case and investment in the pharmacy
procurement team made during 2012. [email protected] Chief Pharmacist is contact
point for further information.
21
Appendix B
Patient Charter
1.0 Purpose of this charter
The purpose of this charter is to provide you with information on homecare medicines services.
It will include the steps you will go through and what you can expect if you are new to homecare. It
will also explain to you your rights and responsibilities, in line with the NHS constitution principles.
The NHS Constitution can be found at:
http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/Overview.aspx
2.0 Introduction
If appropriate, you may be provided with a homecare service for your medicines which will be
ordered by your NHS hospital or clinic. In most cases this will mean your prescribed medicines are
delivered directly to your home by a trusted homecare provider. For some it may also involve some
level of care taking place in your home administered by a healthcare professional.
2.1 Why homecare has a role in medicines provision
Homecare helps to provide you with treatment you need in your own home without the need to go
to a hospital or clinic.
If you have had a stay in hospital, homecare can often help you return home sooner, as well as help
you to be independent and give you more personal control. Or, if you regularly need to attend
outpatient appointments and day units for repeat prescriptions, homecare will save you time by
bringing your treatment directly to you at home.
Not only is this more convenient for you but also helps us to free up appointments as well as
hospital beds – meaning we can care for more people.
2.2 How choice applies
You will have the opportunity to discuss how homecare will work for you and you have the right to
request specific arrangements about how your medicines and/or medical treatments are delivered,
for example on what date and time.
If you require more than one prescribed medicine you can expect the provider to do their utmost to
arrange single deliveries - saving you from receiving several deliveries in a week; however this may
not always be possible.
Your homecare provider is responsible for making your care arrangements – you can expect them to
do their best to accommodate you and your needs however, they cannot guarantee they will be able
to specifically cater to your requests. You can expect to have an explanation if your needs cannot be
met and you can talk about this with your clinical team if you want to.
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3.0 Setting up homecare arrangements
Every patient is entitled to be provided with an understanding of how homecare works and the
different processes which are used to provide the service.
3.1 How services are set up
The homecare providers we use are private companies who are registered to provide medicines and
related medical treatments.
Exactly who will provide you with your homecare will depend on your individual needs and which
companies your hospital uses.
In some instances you may receive a homecare arranged by the company that manufactures your
medicine. They will have set up the arrangements through a designated homecare provider so that
when your clinical team contacts the homecare provider to give them the details of the medicines
you need, they will then arrange the supply. In other cases the arrangements are set up by the
hospital or clinic directly with the homecare provider.
In both cases your clinical team will contact the agreed homecare company with your requirements.
It is then the homecare company’s responsibility to provide your medicine and make delivery
arrangements.
It is important that both of these processes are clear to you and that you understand that your
confidential medical information will be shared with trusted third parties.
3.2 The role of patients in setting up services – the ‘right’ to be engaged
You can expect that the most effective process is being used to provide you with your treatment and
that relevant patient groups are regularly consulted to make sure the best methods are being used.
3.3 The responsibilities of the hospital team and your GP
As for other aspects of care, the hospital doctor, nurse and pharmacist, as well as other members of
the team, have responsibilities to ensure homecare medicine services meet the needs of patients
and are set up in line with agreed standards. They also have a responsibility to let your GP know
which medicines you are being given.
4.0 Initiating homecare medicines for the individual patient –
This section of the charter will cover what you can expect if you are in need of homecare.
4.1 Clinical decision making – right for explanation, engagement, choice
You will speak with a healthcare professional who will provide you with all the information you feel
you need about homecare.
You will have the opportunity to ask the professional any questions you have about the service and
you can expect them to answer as best they can.
Every patient is entitled to this and has the right to accept or refuse treatment.
23
4.2 Registration
After being consulted, you are required to fill out necessary forms to register for homecare.
4.3 Seeking consent, including information
You will also be asked to sign a consent form – this will show that you have understood your
healthcare professional, as well as the information provided to you, and that you are happy to start
homecare treatment.
By signing the consent form you are agreeing to your medical information being shared with trusted
private companies, such as a homecare provider. They will only use the information to help provide
that care.
4.4 Information pack to be provided
At this stage you will be provided with thorough information on how homecare will work for you.
This will include information on your homecare provider.
Every homecare patient can expect to receive this information.
4.5 Provision of the right contact details for different issues
You will also be given contact details for your homecare provider, should you need to get in touch
with them at any stage. You will also have details of who to contact in your clinical team, at the
hospital or clinic.
4.6 Setting up the service
In order for you to receive the best service possible you may need to make very slight changes to
your set up at home. This will depend on your treatment needs, and you can expect to be guided on
this by your homecare provider when they first contact you.
4.7 Initiation document
Every patient will also be required to sign an initiation document. This indicates you have been
happy with all of the information you have received and would like to start benefiting from
homecare.
5.0 First contact with homecare company
At this stage you will hear from your new homecare provider’s customer service team.
5.1 The role of customer service
When your homecare provider contacts you they will provide you with all the information you need
on how their service will work for you.
Every patient is entitled to ask as many questions as necessary and the provider will answer as best
they can.
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6.0 Deliveries
This section of the charter will explain to you what you can expect when your medicines are
delivered to you.
6.1 The standards expected
Where the homecare team delivers your medication every patient can expect to receive a discreet
service and to be treated with respect and dignity, for example, vans making deliveries will not have
information on them that will indicate you are receiving homecare.
Each member of the homecare team who delivers your medicines will be fully CRB checked – this is
the ‘criminal records bureau’ check and it helps ensure the staff caring for you do not have any
criminal convictions.
Deliveries may also be made by couriers or postal services arranged by homecare providers.
6.2 The different methods ie home or pharmacy or appointed place
You may be able to arrange your medicines to be delivered to another address other than your
home, for example your workplace or to a local pharmacy. If appropriate, this option will be offered
to you by your homecare provider.
6.3 Access to home
In some instances a member of your homecare team may need to enter your home in order for
them to help you as much as possible.
Every patient can expect an explanation on why this is necessary and has the right to refuse entry to
the team member.
It is important you understand that the homecare team will only enter your home to help you. If you
refuse them entry you could be left without the care you need.
Homecare staff will carry an identity badge to show who they are, you can expect to be shown this
before letting them enter your home.
6.4 Responsibility for medicines held at home
If you find that you are receiving more deliveries than you need, or perhaps not enough, it is your
responsibility to flag this to your homecare provider, usually by phoning the customer service team.
If you have stock left when a new delivery arrives you should check the older stock is still in date and
use it before starting the new delivery – unless there have been changes in what you should take.
Some medicines require special storage, such as in a fridge, your homecare company will explain this
to you and also explain your responsibilities, this may include checking the fridge is at the right
temperature and reporting any problems.
6.5 Responsibility to be available
The homecare provider will discuss with every patient when they can expect their medicines to be
delivered.
After this has happened, it is your responsibility to make sure you are at home and available to
receive your medicine at the arranged date and time.
25
Make sure you contact the homecare provider customer service team if something unexpected
arises and you cannot be there to accept your medicines.
6.6 Issues re age of person receiving – designated person
All patients will receive a discreet and sensitive service, and for this reason only designated people
may sign for your medicines.
Where possible, it is preferred that you sign for your own medicines. Your homecare provider will
appreciate that this may not always be possible, which is why it is important for you to designate
someone to be able to sign for your medicines on your behalf. The designated person should be an
adult wherever possible.
7.0 Nursing services
For some, it may be necessary for a nurse to visit you at your home to administer your medicines or
provide related care.
Any patient who is also visited by a nurse can expect them to a fully qualified and registered
professional. It is your responsibility to accommodate them in order to help them to complete their
job properly.
8.0 Complaints
If you feel you need to complain about any aspect of your homecare you should contact your
homecare provider to begin with. The details of who to contact should be in your information pack.
You can also contact the hospital or your clinical team.
Homecare companies have a responsibility to pass on any concerns you have to your clinical team.
Every patient has the right to comment on the service they receive.
9.0 If things go wrong
Homecare medicines services are of a high standard but errors can occur. Any patient who believes
an error has been made regarding their homecare has the right to voice their concerns. When you
start on homecare you will be given information about what to do if this happens.
If you would like to talk to someone you should contact your homecare provider. You may also need
to contact your clinical team if you are concerned about what to do.
The homecare company and the NHS will want to learn from any errors so reporting them is
important.
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10.0 Taking your medicines regularly
Once you have started taking your medicines it is important you follow the instructions given and
take them regularly. Doing this will mean you will get the expected benefits and avoid waste. If you
find you have problems or concerns about your medicines you should talk to your clinical team.
If for any reason a member of your homecare team has any concerns about your treatment they
have a responsibility to share this with your clinical team. This would only be to ensure you are
benefiting from the best treatment possible.
11.0 Patient education
Every patient can expect to receive thorough information about how homecare works, as well as
their homecare provider and the medicines you are taking. This will include advice on how to take
you medicine safely.
This will provide you with all of the information you need and something to refer to if you ever have
any questions.
All patients are welcome to contact their homecare provider at any point if they have any queries.
12.0 Feedback – the survey & questionnaire & responsibility to contribute
Every patient will, at some stage, be asked for feedback on their homecare experience. This will
usually be at least once each year.
This will be an opportunity for you to voice your thoughts on the service you receive and will give
your provider the information they need to make their service as good as possible. It is expected
that you will help by providing feedback if you can.
What you say in this feedback will help the homecare company, the hospital and the manufacturer
better shape the service for what you need.
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Appendix C
RPS Professional Standards for Homecare
http://www.rpharms.com/unsecure-support-resources/professional-standards-for-homecare-
services.asp
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Appendix D
Services Handbook
http://www.rpharms.com/unsecure-support-resources/professional-standards-for-homecare-
services.asp
29
Appendix E
Systems - Pharmacy Systems Homecare Recommendations
http://www.rpharms.com/unsecure-support-resources/professional-standards-for-homecare-
services.asp
30
Appendix F
Systems – Output Based Specification (OBS)
http://www.rpharms.com/unsecure-support-resources/professional-standards-for-homecare-
services.asp
31
Appendix G
Systems – Technical specification
http://www.rpharms.com/unsecure-support-resources/professional-standards-for-homecare-
services.asp
32
Appendix H
Gain Share Framework and Guidance
http://www.england.nhs.uk/wp-content/uploads/2014/01/princ-shar-benefits.pdf
33
Appendix J
Medicines Optimisation Clinical Reference Group
http://www.england.nhs.uk/ourwork/commissioning/spec-services/npc-crg/medicines-
optimisation/
34
Glossary of terms Name Acronym Description
Acute services Medical and surgical interventions usually
provided in hospital. Specific care for diseases
or illnesses that progress quickly, feature
severe symptoms and have a brief duration.
Association of the British
Pharmaceutical Industry
ABPI The Association of the British Pharmaceutical
Industry (ABPI) has 150 members including
the large majority of the research-based
pharmaceutical companies operating in the
UK, both large and small. Member companies
research, develop, manufacture and supply
more than 80 per cent of the medicines
prescribed through the National Health
Service (NHS).
Ascribe Ascribe provides a range of IT solutions to
Primary and Secondary Care Pharmacies.
These solutions focus upon delivering
improved healthcare to patients, and are
scalable, allowing single unit/site installations
to Trust wide roll-outs. They are one of
around 8 companies which provide a stock
control pharmacy system as well as medicines
management and ePrescribing within the
hospital setting. See www.ascribe.com.
Blood Clotting Factors BCF The lack of, or insufficiency of, blood clotting factors may lead to inefficient blood clotting. Haemophilia is a condition characterized by excessive bleeding due to a defective blood clot formation caused by faulty genes associated with the production of blood clotting factors, e.g. factor VIII (antihaemophilic factor).
British Generic Manufacturing
Association
BGMA The British Generic Manufacturers
Association (BGMA) represents the interests
of UK-based manufacturers and suppliers of
generic medicines and promotes the
development and understanding of the
generic medicines industry in the United
Kingdom.
35
Name Acronym Description
Board of Commissioners BOC Route for PCT to gain agreement jointly.
Benefits Tracking Tool BTT BTT data warehouse and integrated reporting
tool.
Care Quality Commission CQC Regulate care provided by the NHS, local
authorities, private companies and voluntary
organisations. They aim to make sure better
care is provided for everyone - in hospitals,
care homes and people's own homes. They
also seek to protect the interests of people
whose rights are restricted under the Mental
Health Act.
Chief Executive Officer CEO
Combined Panel Review panel consisted of Mark Hackett, as
Chair, Steering group and Working group
Commercial Medicines Unit CMU CMU work to ensure that the NHS in England
makes the most effective use of its resources
by getting the best possible value for money
when purchasing goods and services. CMU
enhance and safeguard the health of the
public by ensuring that medicines and medical
devices work and are acceptably safe. No
product is risk-free. Underpinning all our work
lie robust and fact-based judgements to
ensure that the benefits to patients and the
public justify the risks.
Commissioning for Quality and
Innovation
CQUIN The Commissioning for Quality and
Innovation (CQUIN) payment framework
enables commissioners to reward excellence
by linking a proportion of providers’ income
to the achievement of local quality
improvement goals.
Department of Health DH
District Health Authorities DHA’s
Drug and Therapeutic
Committee
DTC
Electronic Prescribing Analysis e-PACT A service for pharmaceutical and prescribing
advisors, which allows real time on-line
36
Name Acronym Description
and Cost analysis of the previous sixty months
prescribing data, held on NHS Prescription
Services' Prescribing Database
Enzyme Replacement Therapy ERT A medical treatment replacing an enzyme in patients in whom that particular enzyme is deficient or absent. Usually this is done by giving the patient an intravenous (IV) infusion containing the enzyme. Enzyme replacement therapy is currently available for some lysosomal diseases: Gaucher disease, Fabry disease, MPS I, MPS II (Hunter syndrome), MPS VI and Glycogen storage disease type II. Enzyme replacement therapy does not affect the underlying genetic defect, but increases the concentration of enzyme in which the patient is deficient.
Family Health Service Authority FHSA’s
General Practitioner GP
General Medical Services GMS
General Pharmaceutical Council GPhC The General Pharmaceutical Council is the
regulator for pharmacists, pharmacy
technicians and pharmacy premises in Great
Britain.
Healthcare Resource Groups HRG’s
Home Parenteral Nutrition HPN
High Cost Drugs HCD
JAC JAC provides a single integrated solution
along with associated services and third-party
interfaces. They are one of around 8
companies which provide a stock control
pharmacy system, as well as medicines
management and ePrescribing within the
hospital setting. See
www.jac-pharmacy.co.uk.
Key performance indicators KPI’S Key Performance Indicators are quantifiable
measurements, agreed to beforehand, that
reflect the critical success factors of an
37
Name Acronym Description
organisation.
Manufacturer derived scheme Process by where the manufacturers of the
product works with a homecare provider to
ensure their product/s are delivered to a
patient at home. The NHS has no relationship
or involvement with this arrangement other
than paying for the product and service which
is bundled together
Manufacturers Licence ML Medicinal products manufactured in the UK
must be produced on a site that holds an
appropriate Manufacturer's Licence.
Medicines and Healthcare
products Regulatory Agency
MHRA An executive agency of the Department of
Health. Enhance and safeguard the health of
the public by ensuring that medicines and
medical devices work and are acceptably safe.
No product is risk-free. Underpinning all the
work lie robust and fact-based judgements to
ensure that the benefits to patients and the
public justify the risks.
Medicines Optimisation Clinical
reference Group
MO CRG
Monitor Monitor authorises and regulates NHS
foundation trusts and supports their
development, ensuring they are well-
governed and financially robust.
Multi-disciplinary team Collaborative efforts of professionals from
different disciplines toward a common goal.
Can be made up of Consultant's, Clinician's,
Nurses, Pharmacists and Healthcare Workers.
National Clinical Homecare
Association
NCHA Represents and promotes the interests of
industries whose business is substantially to
provide medical supplies and/or clinical
services directly to patients in the community
within an appropriate quality framework.
Provide a forum for lobbying on issues that
affect homecare. Set and debate policy
decisions with the National Homecare
Medicine Supply Committee and other
38
Name Acronym Description
relevant government bodies.
National Health Service NHS
National Health Service England NHSE
National Health Service Quality
Assurance Staff
NHS QA staff
National Homecare Medicines
Committee
NHMC The National Homecare Medicine committee
(NHMC) is a subgroup of the NPSG.
Membership of the committee comprises of
NHS, CMU, Industry and pharmacy experts on
the use of home care services. Precise
membership will be at the discretion of the
Chairman, NHMC and Deputy Director of
CMU. The key aim of the NHMC is to act as
the national focus for developing and
improving processes for medicines home care
services.
National Patient Safety Agency NPSA Lead and contribute to improved, safe patient
care by informing, supporting and influencing
organisations and people working in the
health sector.
An Arm’s Length Body of the Department of
Health and through three divisions covers the
UK health service.
National Pharmaceutical Supply
Group
NPSG Provides advice to Chief Executive, CMU,
concerning the cost effective purchasing and
distribution of pharmaceutical products to the
NHS in England. Acts as a focal point for the
NHS for pharmaceutical issues of a national
nature and provide pharmaceutical advice
accordingly. Acts as a link between
pharmacists and CMU at national level.
Advises the Department of Health and
pharmaceutical industry on significant
commercial matters.
National Institute for Health
and Clinical Excellence
NICE NICE is an independent organisation
responsible for providing national guidance
on promoting good health and preventing and
39
Name Acronym Description
treating ill health.
National Reporting and
Learning Service
NRLS National safety reporting system. Receive
confidential reports of patient safety
incidents from healthcare staff across England
and Wales. Clinicians and safety experts
analyse these reports to identify common
risks to patients and opportunities to improve
patient safety.
Official Journal of the European
Union
OJEU The Official Journal of the European Union is
the central database for European public
sector tender notices.
Payment by Results PbR
Primary Care Trust PCT Community patient care.
Pulmonary Hypertension PH PH is an increase of blood pressure in the
pulmonary artery, pulmonary vein, or
pulmonary capillaries, together known as the
lung vasculature, leading to shortness of
breath, dizziness, fainting, leg swelling and
other symptoms. Pulmonary hypertension
can be a severe disease with a markedly
decreased exercise tolerance and heart
failure.
Pharmaceutical Price
Regulation Scheme
PPRS A British mechanism for determining the
prices the NHS pays for brand name drugs.
Pharmaceutical Market Support
Group
PMSG Committee of pharmacists from England,
Wales, Northern Ireland and Scotland. A
representative from each purchasing group or
division makes up the English representation.
Provide strategic advice to the
pharmaceutical industry and contracting
groups. The PMSG use market intelligence
including Phate analyses and licence and
patent information.
Pharmex A medicines database which electronically
collates pharmaceutical purchasing data of
NHS hospital trusts in England. The system
supports the management and tendering
process for pharmaceutical contracts and
40
Name Acronym Description
helps provide a comprehensive overview of
medicines usage in secondary care.
In addition to its original objectives, the 54
million lines of data are used in support of DH
initiatives such as monitoring of secondary
care expenditure for PPRS and in providing
increased visibility in the management of
pharmaceutical supply issues.
Purchasing Authority Secondary Care Trusts, Primary Care Trusts,
Foundation Trusts, Collaborative Procurement
Hubs and Confederations.
Quality, Innovation,
Productivity and Prevention
QIPP QIPP is a large scale transformational
programme for the NHS, involving all NHS
staff, clinicians, patients and the voluntary
sector and will improve the quality of care the
NHS delivers whilst making up to £20billion of
efficiency savings by 2014-15, which will be
reinvested in frontline care
Regional Quality Control Regional QC
Royal Pharmaceutical Society RPS The Royal Pharmaceutical Society is the dedicated professional body for pharmacists in England, Scotland and Wales.
Serious Untoward Incidents SUI’s An SUI is in general terms something out of
the ordinary or unexpected, with the
potential to cause serious harm and/or likely
to attract public and media interest that
occurs on NHS premises or in the provision of
an NHS or a commissioned service.
Service Level Agreement SLA A service level agreement (frequently
abbreviated as SLA) is a part of a service
contract where the level of service is formally
defined. In practice, the term SLA is
sometimes used to refer to the contracted
delivery time (of the service) or performance.
Strategic Health Authority SHA
Sub-contractor A subcontractor is an individual or in many
cases a business that signs a contract to
41
Name Acronym Description
perform part or all of the obligations of
another's contract. A subcontractor is hired
by a general contactor (or prime contractor)
to perform a specific takes as part of the
overall project.
Value Added Tax VAT
Value for Money VFM
42
Acknowledgement Organisation Contribution
Mark Hackett North Staffordshire Hospital NHS
Author of Homecare Medicines – Towards a Vision for the Future and follow up report Taking Forward the Recommendations. Chair of the board.
Dr Keith Ridge NHS England Senior Responsible Officer (SRO)
Chris Theaker Department of Health – Commercial Medicines Unit
Project Director and Procurement Task Group Led
Howard Stokoe Department of Health – Commercial Medicines Unit
Board and Task Group Member
Andrew Alldred Harrogate & District NHS FT Board Member and Systems Task Group Lead
Ray Fitzpatrick Royal Hospital Wolverhampton Board Member and Standards and Handbook Task Group Lead
Carol McCall National Clinical Homecare Association (NCHA)
Board Member and deputy Work Stream Lead Standards and Handbook Task Group Lead
Allan Karr National Homecare Medicines Committee (NHMC)
Board and Task Group Member
Martin Stephens Southampton University Hospital NHS FT
Board Member and Task Group Lead for both Governance and Patient Engagement
Clare Howard NHS England Board Member and author of Gain-share framework and guidance
Sheila Uphadya National Commissioning Group Board Member
Kim Gay Leeds Teaching Hospital NHS Trust
Board Member
Mark Cartwright British Generic Manufacturers Association (BGMA)
Board Member
Nick Payne Association of the British Pharmaceutical Industry (ABPI)
Board Member
Sam Ogden Association of the British Pharmaceutical Industry (ABPI)
Board Member
Jon Cohen National Clinical Homecare Association (NCHA)
Deputy Task Group Lead
Liz Payne Department of Health – Commercial Medicines Unit
Board and Task Group member
Andrew Davies Pharmacy Business Technology Group (PBTG)
Task Group Member
Graeme Duncan National Clinical Homecare Association (NCHA)
Deputy Task Group Lead
Natalie Juryta Department of Health Project Manager
43
Lindsey Carman Department of Health – Commercial Medicines Unit
Project Office support
Royal Pharmaceutical Society